P382. Predictor of effect of oral tacrolimus on refractory ulcerative colitis
A. Ito, B. Iizuka, M. Takahashi, T. Omori, M. Yonezawa, K. Shiratori, Tokyo Women's Medical University, Department of Gastroenterology, Tokyo, Japan
Patients who received tacrolimus (TAC) administration for refractory ulcerative colitis (UC) at our hospital were divided into those who did and did not achieve clinical remission (clinical remission and non-remission groups, respectively), and a predictor of the effect of TAC was investigated.
Twenty-nine patients treated with TAC between February 2010 and October 2013 were divided into the clinical remission group consisting of 24 patients (12 males and females) and non-remission group consisting of 5 patients (5 males). TAC was administered in a fasting state or before meals at a single dose of 0.025–0.075 mg/kg, twice daily, as a rule. The target blood level was set at a trough level of 10–15 ng/ml after 2 weeks of administration, and the trough level after 2 weeks was adjusted to 5–10 ng/ml. The clinical activity was evaluated using the Lichtiger score (CAI) before the initiation of TAC administration and at the time when the blood TAC level reached the target level. The CAI score before TAC administration was 10 or higher in all patients. Clinical remission was defined as a condition with a CAI score of 4 or lower after 4 weeks of TAC administration.
The endoscopic findings before the introduction of TAC were evaluated using the UCEIS and EAI, and the clinical background was investigated with regard to the gender, age, affected area, duration of illness, total dose of PSL administered 4 and 2 weeks before introduction of TAC, CRP and Hb on admission, CAI before TAC administration, and time required for the blood TAC level to reach the target level, but no significant difference was noted in any item. However, a significant difference was noted in the CAI score at the time when the blood TAC level reached the target level between the clinical remission (8±3.2) and non-remission (12±2.6) groups (p < 0.05). When the interval estimation of the mean CAI score was compared between those on admission and at the time of reaching the target TAC level, the reduction rate was 41.7–55.1% in the clinical remission group and 13.8–37% in the non-remission group.
The rate of reduction of the CAI score from that before TAC administration to that at the time of reaching the target blood TAC level may be an important predictor of the effect.